On “Elderhood”

A new book by geriatrician Louise Aronson calls us to rethink medicine, aging, and life itself.

This began as an old age book, and then became more than that, including a book about medicine and what it means to be a human being.

The opening words of Elderhood: Redefining Aging, Transforming Medicine, Reimagining Life are intriguingly inviting because they express the author’s desire to achieve a goal that requires undertaking two monumental tasks: 1) explaining the intersectionality of “old age, medicine, and American life” and 2) clarifying that intersectionality for a variety of audiences –– older adult patients and their caregivers, physicians, healthcare administrators, research scientists, government policy-makers, and, in fact, anyone who is aging (which means all of us).

Dr. Louise Aronson

This eloquent and impressive book, the second by Louise Aronson, geriatrician and professor of medicine at University of California–San Francisco, simultaneously explores aging in the context of the American healthcare’s system of practices and examines that system’s problems as exemplified by its treatment of old patients. As with her first book, the highly acclaimed collection of short stories A History of the Present Illness,Aronson uses her keen powers of observation and empathy to highlight the ways in which people, especially older adults, are seen –– or not –– by medical professionals and society in general for the whole human beings they are. As she pointedly observes:

While it may be too early to know for sure, I suspect that old age is the “illness” metaphor of this century. It invokes visions of the aged human body as broken-down machine or outdated software. And those are only the beginning….Words and metaphors can bring or strip distinction and status. We need to reclaim the unpopular words of old age to associate them with their original meanings. Old is the term for life’s third act, just as youth is the word for its first. It refers to much more than the late-stage phase of loss and disenfranchisement. Better still, if we didn’t deny people’s humanity as they reached that late stage, there would be no need to lament the language and metaphors of old age.

In this new work, Aronson makes a serious case for reforming our ageist cultural beliefs and our medical institutions, which inadvertently work together to negatively affect our health and quality of life, no matter how old we are. A Harvard-trained physician dedicated to caring for old people, she makes it clear where her affinity lies:

The scientist works for knowledge, while the doctor works for the patient. This critical distinction is too often forgotten in our current health system….With science at the center of medicine’s paradigm, we prioritize things; if we put care at its center instead, our priority will shift to where it should be: people.

Aronson models this caring approach by making people the focus of her book. Effortlessly weaving hard science, clear argument, and storytelling, she documents real-life instances of system-generated physician burnout, wasted money, social inequity, medical errors, and patient death. The result is a powerful profile of an inefficient, materialistic, and often unintentionally cruel healthcare system that cries out for reform.

Among her exceptional skills is the ability to position the reader in the heart of a situation, as when she is illustrating the emotional chaos that can be experienced by a person with dementia:

Imagine your reaction if a stranger started taking off your clothes. If you felt cold but couldn’t find or ask for a sweater, or you had to pee but couldn’t undo your clothes or were in a new place and couldn’t find the bathroom. And what if you looked in the mirror and didn’t recognize yourself, or sat in your home minding your own business when a stranger appeared claiming to be a doctor, asking you questions you couldn’t answer, then wanting to touch intimate parts of your body?

Her point is that a person with dementia is still a person. And isn’t that how all of us would want to be seen, regardless of our health challenges? As a narrator, Aronson effortlessly embodies the points of view of patient, caregiver, and physician, and brilliantly weaves into the structure of the book’s main sections (Conception, Birth, Childhood, Adulthood, Middle-aged, Elderhood, Death, and Coda) her own evolution as a geriatrician. In her own words, the book “dances,” and the reader bears witness to the sometimes painful and always rewarding psychological movements of her professional growth.

Elderhood is a landmark work that argues for a greater understanding and wider utilization of geriatric medicine as well as a long-overdue re-visioning of what it means to grow old. In a world of increasing numbers of older adults, Aronson’s highly readable, absorbing, and thought-provoking book should serve as a guide for how our culture must change in order to provide a future in which all of us can age well throughout the span of our lives. For an “old age book” that is “about medicine,” she faithfully succeeds in transmitting the core of her message:

In contemplating what medicine is and should be, whether for old patients or younger ones, I prefer the famous words from the original Hippocratic oath: to cure when possible, to heal sometimes, to care always….When a phase of life is considered difficult, and when, on top of that, the group currently living through that phase is neglected, disparaged, and vilified, opportunities to relieve distress and make a real difference are countless.…How much better and richer would life be for all of us in a society that cared for a ninety-two-year-old for the simple reason that the ninety-two-year-old is a human being, and we care about human beings.